Healthcare Provider Details

I. General information

NPI: 1952161663
Provider Name (Legal Business Name): KATHERINE M CASANOVA LCSW, DBH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 W WYOMING ST
TUCSON AZ
85757-9544
US

IV. Provider business mailing address

5625 W WYOMING ST
TUCSON AZ
85757-9544
US

V. Phone/Fax

Practice location:
  • Phone: 520-373-4771
  • Fax:
Mailing address:
  • Phone: 520-373-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW21883
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: